Kealy S Adams, CCC-SLP

Individual provider Active NPI Speech-Language Pathologist · Portland, OR

NPI 1073704201 · NPPES record last updated Jan 7, 2014

Key facts

NPI
1073704201
Entity type
Individual (NPI type 1)
Primary specialty
Speech-Language Pathologist 235Z00000X
License
LL60016408 (WA)
Practice address
4560 SE International Way
Portland, OR 97222-4628
Phone
(971) 206-5205
NPI assigned
Aug 5, 2007
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
LL60016408WAMDSpeech-Language Pathologist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X LL60016408 WA Yes

Addresses

Primary practice location

4560 SE International Way
Portland, OR 97222-4628

Mailing address

4624 S 214TH PL
Kent, WA 98032-8479
Phone (650) 279-6382

Other providers in Portland, OR

All providers in Portland, OR · Speech-Language Pathologist in Oregon

Sources for this page

Verify at the official NPI Registry.